| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
11,336 |
10,818 |
$457K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,935 |
3,726 |
$428K |
| D0120 |
Periodic oral evaluation - established patient |
12,202 |
11,645 |
$334K |
| D1351 |
Sealant - per tooth |
3,682 |
2,711 |
$304K |
| D1206 |
Topical application of fluoride varnish |
7,897 |
7,439 |
$199K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,596 |
3,233 |
$141K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,911 |
1,590 |
$92K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,472 |
2,451 |
$66K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
775 |
659 |
$57K |
| D0220 |
Intraoral - periapical first radiographic image |
8,028 |
7,585 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,977 |
1,907 |
$45K |
| D0272 |
Bitewings - two radiographic images |
3,925 |
3,704 |
$38K |
| D0274 |
Bitewings - four radiographic images |
1,489 |
1,447 |
$28K |
| D9110 |
|
523 |
490 |
$26K |
| D7140 |
Extraction, erupted tooth or exposed root |
520 |
457 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,309 |
5,982 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
1,380 |
1,354 |
$24K |
| D1110 |
Prophylaxis - adult |
248 |
248 |
$12K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
60 |
48 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
164 |
163 |
$4K |
| D0330 |
Panoramic radiographic image |
54 |
54 |
$1K |
| D2331 |
|
15 |
13 |
$743.90 |